Nearly half of adolescents with lifelong HIV infection were found to have evidence of coronary artery atherosclerosis, putting them at elevated risk for cardiovascular disease, according to a study published in the December 23, 2013, advance edition of Circulation.

Numerous studies have shown that HIV positive adults have a higher rate of heart disease than the general population, but whether this is attributable to HIV itself, resulting metabolic or inflammatory changes, toxicities of antiretroviral drugs, or other factors is not fully understood.

Kunjal Patel from Harvard School of Public Health and colleagues with the Pediatric HIV/AIDS Cohort Study measured buildup of plaque in the coronary arteries and abdominal aorta of 165 adolescents with perinatal HIV infection and long-term exposure to antiretroviral therapy (ART). They found that 48% had coronary artery atherosclerosis and 24% had aortic atherosclerosis. Significant predictors of atherosclerosis included male sex, history of an AIDS-defining condition, and longer duration of ritonavir-boosted protease inhibitor use.

February 24, 2014 -- Nearly half of adolescents who have had HIV since birth may be at increased risk for cardiovascular disease -- including heart attack and stroke -- later in life, according to a National Institutes of Health network study.

The findings are the latest results from the Pediatric HIV/AIDS Cohort Study (PHACS), a multi-site, long-term follow-up study of children and youth who have had HIV since birth, sponsored by the Eunice Kennedy ShriverNational Institute of Child Health and Human Development (NICHD) and supported by eight other institutes at NIH.

The results are based on clinical assessments of 165 teens age 15 or older with HIV, who were born to mothers with HIV and who have been treated with anti-HIV medications since birth.

The researchers estimated each study participant’s overall cardiovascular risk using a score based on measures of cholesterol levels, blood sugar level, smoking, blood pressure, and weight. The combined score has been shown to predict the presence of buildup and thickening in the major arteries to the heart and abdomen, known to increase the risk for conditions such as heart attack and stroke.

The study results were published online in Circulation.

According to the study authors, previous studies have found that the severity of HIV infection and a history of taking specific HIV drugs are linked to cardiovascular disease in adults. The current study is the first to evaluate overall risk for cardiovascular disease in teens with HIV infection since birth.

The study’s first author was Kunjal Patel, DSc, MPH, of the Harvard School of Public Health, in Boston. Other authors were from the 14 institutions affiliated with the PHACS Network.

"Our results show that a large proportion of teens who have had HIV their whole lives appear to be at significant risk for cardiovascular disease later in life," said co-author George Siberry, MD, of NICHD, one of the NIH institutes supporting the study. "These results indicate that individuals who have had HIV since birth should be monitored carefully by their health care providers for signs of cardiovascular disease."

To calculate a participant’s cardiovascular disease risk, the researchers used a scoring system called the Pathobiological Determinants of Atherosclerosis in Youth, or PDAY. The PDAY score is calculated on the basis of a person’s cholesterol levels, blood sugar levels, weight, and other factors known to influence risk of cardiovascular disease. The score estimates the likelihood that a person has a build-up of artery clogging plaque in the coronary arteries or in the abdominal aorta (the main artery in the abdomen). Researchers consider a PDAY score of 1 to indicate an 18 percent or 24 percent greater chance of plaque build-up in the coronary arteries or abdominal aorta respectively, compared to a score of zero, thought to indicate the chances for cardiovascular disease among those of the same age and sex with no known risk factors.

Of participants in this study of adolescents with HIV infection since birth, 48 percent had a score of 1 or higher for the coronary artery measure. For the abdominal aorta measure, 24 percent scored 1 or above. The researchers also evaluated changes in PDAY scores over a four-year time period and did not observe any major trends.

The study authors noted that PDAY scores of 1 or higher were primarily attributable to high cholesterol levels. Other risk factors, such as smoking and high blood pressure, that are more common in older adults, were uncommon in these young participants. Participants who were treated with the HIV drug class known as protease inhibitors were more likely to have higher PDAY scores. Teens with a history of AIDS were also more likely to have higher PDAY scores. This study only looked at HIV-specific factors influencing cardiovascular risk in this group. It did not look at other factors such as diet, physical activity, or genetics. The study authors called for more research to understand all the potential factors that could influence cardiovascular risk in this group.

"It’s too soon to recommend changing treatment regimens on the basis of our findings," Dr. Patel said. "Until we can learn more, we can best serve adolescents who have HIV by monitoring their risk factors for heart disease carefully and urging them to adopt other measures that have been found to reduce the risk of heart disease in the general population: exercising, maintaining a healthy diet, and not smoking."

In addition to funding from the NICHD, support for PHACS is also provided by the National Heart, Lung, and Blood Institute; the National Institute of Alcohol Abuse and Alcoholism; the National Institute of Allergy and Infectious Diseases; the National Institute on Deafness and Other Communication Disorders; the National Institute of Dental and Craniofacial Research; the National Institute on Drug Abuse; the National Institute of Mental Health; the National Institute of Neurological Disorders and Stroke; and the NIH Office of AIDS Research.

About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD):The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute’s website at http://www.nichd.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.